Earlier Submissions

ACT Patient & Family-Centred Care Model Submission

Patient-focused and patient-centred are terms that have existed in the Australian health language for many decades. While both approaches acknowledge involvement with the family as a fundamental element of care, there are key differences:

In family-focused care, professionals often provide care from the position of an ‘expert’ assessing the patient and family, recommending a treatment or intervention and creating a plan for the family to follow. They do things to and for the patient and family, regarding the family as the ‘unit of intervention.’ Family-centered care, by contrast, is characterized by a collaborative approach to caregiving and decision-making. Each party respects the knowledge, skills, and experience that the other brings to health care encounters. The family and health care team collaboratively assess the needs and development of the treatment plan.

The ACT Government publication your health – our priority, identifies patientcentredness as its top principle underpinning health care into the future. Patient-centred care is fundamental to each of the models of care being developed to inform the major health infrastructure program currently being undertaken in the ACT.

We are strongly in support of a Patient and Family-Centred Care Model in the ACT which would facilitate a partnership approach to the physical and mental health care of Consumers. We support a healthcare system that allows Consumers to have access to the care they want, when they need it and in a way that suits them which includes them as a Consumer and those people that have a caring role in their lives. This approach is also consistent with the underlying principle of the 4As Framework for Preventing Further Episodes of Mental Illness :

Mental health care should be responsive to the continuing and differing needs of consumers, families and carers, and communities.

We advocate that The Patient and Family-Centred Care Model would promote prevention and early intervention and support Consumers to have greater control of their lives.

SUMMARY OF RECOMMENDATIONS

Recommendation 1: Make reference to the Mental Health Recovery in the ACT document.

Recommendation 2: Include contact Information about the ACT Mental Health Consumer Network Consumer Representatives Program in the framework for the Patient and Family-Centred Care Model in the ACT.

Recommendation 3: Include contact information about the Carers ACT Mental Health Carers Representatives Program in the framework for the Patient and Family-Centred Care Model in the ACT.

Recommendation 4: Make reference to the Mental Health Consumer and Carer identified workforce which will be included in the National Mental Health Workforce Strategy when it is issued later in 2011.

On 20 April 2010, the Australian Government and state and territory governments, with the exception of Western Australia, reached an historic agreement at Council of Australian Governments (COAG), on health and hospitals reform. The establishment of the National Health and Hospitals Network (NHHN) represents the most significant reform to Australia’s health and hospitals system since the introduction of Medicare.

Under the NHHN Agreement, the Australian Government will take full funding and policy responsibility for primary mental health care services for common disorders such as anxiety and depression of mild to moderate severity, including those currently provided by states and territories.

Building on the existing reforms already underway, on 27 July 2010, the Prime Minister, the Hon Julia Gillard MP, stated that mental health will be an important second term agenda for the Government, announcing the “Taking Action to Tackle Suicide” strategy. Under this strategy, $274 million will be invested over four years.

As part of this package $60 million will be available over three years from 2011-12 to extend funding pools available under the Flexible Care Packages for People with Severe Mental Illness measure to enable access to non-clinical support services, such as structured social activities, psychosocial rehabilitation, vocational support or respite services for carers. This complements clinical services and case management available under the original allocation to Flexible Care Packages, and will enable wrapped around care to be tailored to the needs of the individual.

What are Flexible Care Packages?

A Flexible Care Package (FCP) is a package of care which is tailored to meet an individual’s needs and will comprise of the following components:

funding to purchase clinical services:

the capacity of funding case coordinators to work closely with the referring GP or psychiatrist and assist individuals navigate the clinical and social support they need;

new funding to purchase the required community/social support services; and

an emphasis on links and flexible pathways to broader clinical and support services, including Commonwealth, State and Territory and NGO services such as specialist mental health services, acute services, crisis support, and broader vocational and community support.

We are in support of a personalisation approach to mental health care that would allow consumers to have access to the care that they want, when they need it, and in a way that suits them. This would allow people to access the services that best target their needs and that do this at suitable times and places. This approach promotes prevention and early intervention and supports consumers to have greater control of their lives.

A true personalisation approach acknowledges that people receiving support should be able to make choices about how they live their lives, with territory-funded services more tailored to individual choices and preferences in all care settings. This means thinking about public services and social care in an entirely different way, with each client developing or deciding on a support plan that outlines how their needs and outcomes can be met.

The Network sees the potential of flexible care packages (FCPs) to change the way mental health services are delivered to suit consumer needs and circumstances. This would mark a positive move away from the current situation where the onus is on consumers of mental health services to adapt to the way services are delivered.

Summary of recommendations

Recommendation 1: FCPs should be targeted at mental health consumers with complex needs and should not focus on the severity of their mental illness or their engagement in the workforce.

Recommendation 2: Develop a simple model of care where GPs, psychiatrists and social workers can refer consumers to a care coordinating service that will then match consumer needs with suitable ATAP programs (Tier 1, Tier 2 or FCPs).

Recommendation 3: Fund the production, by consumers, of user-friendly consumer information on how to navigate the mental health system and access psycho-social support services.

Recommendation 4: FCPs should allow the consumer to access a range of services that are identified to be important for consumer wellbeing.

Recommendation 5: Evidence from a range of consumer stories and experiences during the implementation of FCPs should be sought through consultations with consumer advocacy groups, including the Network.

The Review of the Mental Health (Treatment and Care) Act 1994 (the MHA) commenced in 2006. The purpose of the Review is to ensure that the mental health law, as it applies in the ACT, reflects best practice in mental health law. The characterisation of best practice is influenced by the current needs and values of the ACT community in seeking to protect, promote and improve the lives and mental well-being of its citizens.

The Review is a jointly managed by ACT Health and the Department of Justice and Community Safety. The ACT Mental Health Act Review Advisory Committee (referred to here as ‘the Committee’) will make recommendations to the ACT Government about how the law should change. The Committee includes people from the ACT Government and community agencies involved in mental health and disability services, people involved in the law, and consumers of mental health services.

The Review is currently exploring capacity law as an alternative legislative framework and the Coalition is encouraging this while simultaneously acknowledging the questions to be resolved to make this path viable.

The ACT Mental Health Consumer Network has joined with the Mental Health Community Coalition ACT, ACT Mental Health Carers Alliance and Carers ACT to call for the establishment of a legal framework for advanced mental health care directives and the extension of Enduring Power of Attorney to include decisions about psychiatric treatment.

National Mental Health Workforce Strategy

A National Mental Health Workforce Strategy is currently being developed by the National Mental Health Workforce Advisory Committee in conjunction with consultants Siggins and Miller.

The Network has raised several concerns over the Draft Position Statement.

Key concerns:

The Draft Position Statement does not take a holistic view of mental health consumer involvement in the provision of mental health services, by over-focusing on what appears to be a narrowly defined category of identified positions. This has the potential to deny access to specialised support for consumers who work in the mental health sector but not in the capacity of an identified position.

The narrowly defined category of identified positions for certain positions may inadvertently impose a restraining effect on the consumer’s ability to play a greater role in a non-identified position which might include higher level decision-making positions.

In response to an invitation from the National Advisory Council on Mental Health (NACMH) to tender a written submission on ‘Daily bread, income and living with mental illness’, for the purpose of informing the NACMH’s advice to the Minister for Health and Ageing on the extent of income-related difficulties faced by people with mental illness and their families, and how these difficulties might be remedied, the Network suggested three remedies should be pursued in order of priority:

1. Personalised budgetsThe Network advocates for personalised budgets as the most important and urgent priority for addressing income-related difficulties of people with mental illness. This approach promotes prevention and early intervention and supports consumers to have greater control of their lives. It also leverages market forces to drive services to respond better to consumer needs.

The idea of personalised budgets is not fanciful; the British Government has already started to transform the way it delivers public services to adopt a personalised support package approach. This ‘personalisation’ approach acknowledges that people receiving support should be able to make choices about how they live their lives, with state-funded services more tailored to individual choices and preferences in all care settings. This means thinking about public services and social care in an entirely different way. Every person can decide how to plan their support, develop a support plan outlining how their needs and outcomes can be met or to opt to direct their own support and have a personal budget.

Being given access to a personal budget means mental health consumers can:

purchase their own care and support if they choose to;

purchase services that are tailored to suit their specific needs, preferences and circumstances;

have greater control, choice and flexibility in their day-to-day lives; and

be much more involved in helping government develop and shape services.

There are several ways that a personal budget can be spent and managed, but they are all based on the same key idea – consumers should get the care that they want, when they need it and in a way that suits them.

2. Disability insuranceThe Network supports the idea of disability insurance, where people who decide to get off their DSP and enter paid employment can benefit from a safety net if they experience relapse and need to take some time off employment. Disability insurance should ensure that the costs of basic necessities – including housing, food and treatment – are covered while people are managing their illnesses and applying for other income support such as DSP.

3. Targeted employment and employment support programsPaid employment opportunities for mental health consumers need to involve best practice human resource management. Employees should be able to access support when they need it and should not be discouraged from taking sick leave to deal with their mental illnesses. Employment opportunities should be fulfilling and based on the person’s interests, abilities, skills and previous experience; it can be empowering for consumers to know that their employment is not simply about obtaining income.

ACT Health Proposes to establish a new structure that enables the portfolio to capitalise on the opportunities that are currently being presented to the organisation, and those that will arise in the future.

These opportunities include:

a) The ACT's increasing deman for services, and their response to this need

b) The major rebuild of ACT Health's facilities under the Capital Asset Development Program; and

c) The National Health and Hospital Reform program, and our preparation for these changes.

The proposed structure include the realignment of community health division functions. It is proposed that the functions currently performed in the Community Health Division be redistributed across other divisions.

The main proposed changes include aligning the Alcohol and Drug Program and Corrections Health Program alongside Mental Health ACT. The rationale is to encourage a 'No Wrong Door" approach due to high levels of co-morbid mental health problems. Aligning the two programs alongside Mental Health ACT would aim to improve integration of services and continuity of care. The name of the Division would be changed to reflect this amalgamation.

The Network has submitted two letters regarding concerns over the naming of the division. Our area of concern naturally falls within the division of Mental Health ACT and we support the efforts of ACT Health to improve integration of services that will facilitate better continuity of care for Mental Health Consumers with co-morbid mental health issues. However we do not want mental health consumers to be further stigmatised.

The naming of the division should be carefully constructed so it would not exarcebate the stigma of any of the consumer groups. We strongly object to the idea of combining the name of the three programs or any other naming convention which focuses on the adverse state of an individual’s situational health needs. We consider that this will compound the stigma already facing individuals within these groups by essentially lodging them under a banner akin to 'Stigmatised Individuals’ Services ACT'.

We suggest naming possibilities such as Social Health Services ACT or Well-being Rehabilitation Services ACT or Community Health Services ACT in order to demonstrate that there are more suitable options available that do not further disadvantage individuals in need of support and assistance.

National Framework Advance Care Directives

In 2009 Australia’s Health Ministers endorsed the development of nationally consistent best practice guidelines for the use and application of advance care directives within the broader context of advance care planning.

A draft National Framework for Advance Care Directives has now been produced by a Working Group of the Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers' Advisory Council. The Working Group is now seeking comments from stakeholders.

The Working Group has engaged HWL Ebsworth to conduct the consultation and report on its findings.

The Network has submitted a submission to address the gap in the Draft Framework in relation to current State and Territory legislation. The Network recommend the Draft Framework to include the Mental Health Acts of the States and Territories to be included in the investigations.